Sunday, August 16, 2015

Girls are from venus boys are from....

'MARS' or as my unit likes to call it.. Molecular Adsorbent Recirculating System which is pretty much dialysis for the liver. It is one form of artificial liver support and a treatment modality indicated for patients with acute liver failure, most commonly from drug overdose. Click here to learn more about MARS Therapy and how it actually works!


(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice.

Monday, August 10, 2015

ELAD

I'm sure you're probably wondering why I wrote an acronym out in this heading...  and that is because I wanted you to present this concept to you EXACTLY as it was presented to me initially. The first thing I did was google search and WALLAH!! There it was Extracorpeal Liver Assistant Device aka ELAD. Ultimately, it works as a mechanical liver. Similar to how CRRT works as a mechanical kidney when acute failure involved. ELAD improves survival rates with liver failure patients. Click here to learn more about ELAD Therapy. Ultimately, it works as a mechanical liver.



(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice.


Thursday, July 30, 2015

Time flies

Geez where did all the time go... I am approaching my last month on orientation (can you guys believe it!?). I can remember Day 1 like it was yesterday.. brushing through those double doors and opening a can of sensory overload..from hearing ventilators alarming to pumps beeping.. it was music to my ears! I observed the flow of the unit starting with AM critical care rounds and the involvement of different medical personnel (dietary, physical therapy, GI, Infectious Dz, Liver transplant..etc) working as a team to better the patient's care. Thinking back to that day, I can say it has truly been a journey.. no it was not easy.. the learning curve was very steep and still is. Yes, it was VERY overwhelming at times.. but with patience, perseverance and dedication.. you can get through it! For those of you who might be new nurses in your area of specialty who have made it over, what I call.. "the struggle hump".. CONGRATS! The worst is over!



"Fruit for thought"



Thursday, July 16, 2015

ICU Problems

"When you leave your stethoscope on the unit and come back the following week and its right where you left it"


Dear Littman Cardiology II, that is 
purple with  rainbow gold finish..
come to me NOW! lol 



                    "Bright RED bloody stools"


Nor is it a great smell! Actually it is one that will forever be remembered after it burns its way into your nostrils! This was my first GI Bleed but I knew it would not be my last. First things first! I checked the pt. vitals, which were steadily declining (no surprise) but then again he just started his HD treatment..(how's that for clouding the picture)...then I checked his last hemoglobin, which was great--for now at least. I am already anticipating that he will need blood though so before going to the mid-level I check the transfusion data to see if he has a current sample (he didn't) went to the mid-level and told him what happened along with all of the above and we sent a type & cross as well as a CBC. 



                        "Nothing like a fresh OLT"


Sometimes, Orthoptic Liver Transplant (OLT) patients come straight to 
our unit from the OR (depending on how critical they are)..and when they are 
critical... they are usually quite jaundiced AKA "banana-looking'! lol 
Click here to learn more about Liver Transplants! 



                                         "Precisely!"
 And CYA! I'm sure I don't have to explain that acronym! 







(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice.

Saturday, July 4, 2015

4th at the hospital

And guess who comes to pay a visit... JACHO AKA Joint Commission on Accreditation of Healthcare AKA 'unit-must-be-perfect-on-this-day"..The Joint Commission accredits healthcare organizations across the United States and are recognized as the symbol of quality. Hospitals aren't told an exact date to expect JACHO in efforts to avoid any special preparation from the unit exclusively for a visit. They visit every three years and provide the organization with any standards that were cited for improvement. To learn more about JACHO and their standards, click here

 "When I found out JACHO was on the unit"


We had been expecting them any day now so of COURSE they 
had to come on 4th of July!



"JACHO's here!"



Everyone always acts all "OMG-they're-here-walk-upright-and-smile" when 
they come but we shouldn't act any different..
keyword=shouldn't



      LOL!


 And have a great day!




(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Wednesday, July 1, 2015

It's the first of the month!

Well it's July 1st AKA 'fresh-new-residents-on-the-unit' day... Every July, medical residents who have just graduated from medical school come to the unit and begin learning how to become safe, competent physicians ((how exciting scary!)). Though I am new as well, I soon learned exactly what that meant! For new residents, there is a knowledge deficit between what was learned the past four year in BOOKS vs what needs to occur in REAL LIFE.. so as the nurse you have much more 'hands on' experience and a much broader knowledge base than a first-year resident so you have to be patient and in some situations, guide the residents.. one might not know how to write an order.. or what to do in emergency situations.. and that is where you step in!!

"How the new residents look walking into a patients room before  morning rounds"


Be that 'helpful nurse' to the resident, not the mean 
'learn how to do it yourself' nurse!



 "When I ask the resident to order a PCA for my fresh surgical patient and they tell me they don't know how to"



No worries! I'll just ask the pharmacist



"When the resident wants me to take restraints off my patient with hepatic encephalopathy 
because they are calm at the present moment"
 It only takes one tug at that A-line OR unbridled DHT 
for real issues to arise.. just trust me, lets not!



"Me: So what do you think we should do about the patient's declining respiratory status?"

                                                                          (Resident)

 Oh okay well take a look at their last ABG.. I think we should intubate STAT!


(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Monday, June 22, 2015

New nurse problems..


"Pretty much!"

Sometimes giving report to certain nurses can be a challenge. 
Some wait for youto leave out the smallest detail 
so they can jump down your throat while 
others are helpful and hint at information that might have 
been left out.. with time it gets better! 

"How I feel when I ask questions"

 There are no dumb questions when you are learning! Some 
nurses forget that after gaining lots of experience but never let
it affect you or you're learning. ASK ON!


"Preceptor problems"
'Some preceptors' are very 
nit-picky/particular/dramatic/think-you-are suppose-to-do-EVERYTHING-right-the-first-time..
as a new nurse I am learning.. no it won't be perfect the first time I do it...maybe not even the 3rd! 
BUT some preceptors forget what it is like to be new so try not to take it personal.
They just want you to be PERFECT -_-


"Preceptors be like"

                                                            Learn from your mistakes!

(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).


Monday, June 15, 2015

Code MET



This week I responded to a Code MET.. A Code MET is called when there is a medical emergency in the hospital that requires intervention by the medical emergency team (MET) which consist of an ICU nurse, Respiratory therapist (RT) and a Doctor. When I heard the Code, my preceptor told me I should go to it to see how they're ran and what our role is during one.. so I did, with another ICU nurse of course.. before arriving all I could think about is what could have went wrong with this patient.. Atrial Fibrillation (A.fib) w/rapid ventricular rate (RVR)? Hypotension? Shortness of breath (SOB)?.. upon exiting the elevator a Code Blue was called to the exact room we were heading to which meant the patient stopped breathing.. as we headed down the hall all I could see were the different medical personnel running in and out of the room.. once we arrived the nurse I was with started compressions while someone else bagged the patient.. the Physician Assistant (PA) from our unit ran the Code.. and it wasn't long before I was passing 1mg of Epinephrine to my fellow coworker. Apparently the patient aspirated (<--choked) on water and stopped breathing shortly after.. 10 minutes into the code, we finally obtained a pulse and a blood pressure and rushed the patient down to our unit where we began prepping them for intubation (placing the breathing tube in) since they could not protect their airway and arterial line (A-line) placement to closely monitor their blood pressure (BP).. though the patient remained critical for several days, he survived.
 

                                                       "Thinking to myself"




 (Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Monday, June 8, 2015

New grad life..

                                                                     "Always"



                     "First couple months had me like..."

                       


                "What my coworkers keep telling me"
                                    

(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Monday, June 1, 2015

2015 nursing graduates!

 Now that nursing school is over, the REAL work begins... First and foremost, CONGRATULATIONS! I know at times it felt like you would never make it to see this moment but--you did and you deserve to celebrate every second of this accomplishment! All the late nights, studying, exams, STRESS, and more STRESS has finally paid off. You are done with the hardest  part of becoming a nurse BRAVO! Now comes the NCLEX and job hunting which bring forth a NEW stress.. that's nothing like nursing school.. it's called being a new nurse!



(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Monday, May 18, 2015

"Cuz ya had a bad day!"

Ever had one of those shifts when you just can't keep up no matter WHAT.. yeahhhhh that happened to me today! Not a 'great' feeling but shit happens and you just have to keep it moving best you can.. there will be days that don't flow nice and smooth like you planned at 0700 and that's ok! Especially if you are new because you are still getting the hang of things. You never know what awaits you walking into work.. you're patient could be stable and ready for transfer to the floor, what we call a 'TTF', OR they could be ventilated and hemodynamically unstable requiring several pressors JUST to maintain a blood pressure! After awhile, you get used to the flow of your work day no matter what type of patients you have.. but until then..you may fall behind so if you have a bad day.. its OK--I did today and we ALL do some days.
                                                                     "....today"




"When I'm in one of my patients room and I hear the CRRT alarm going off in my other patients room"

 
  


                                    "When I realize how behind I am"
                                                               
                                      


                                                           "Time-to-GO!"

 
"At home like" 


 


 


(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).

Saturday, May 16, 2015

3 down! 3 to go!

Three months ago today, I started my residency as a new graduate nurse in a Surgical/transplant ICU.. In this residency, we are allotted 6 months to work with a preceptor and learn as much as possible! Over the past few months, I have learned soo much and I continue to each week.Yes it is stressful and I have made my share of mistakes 'learn from this moment' incidences but that is part of what being a new nurse is all about. From ECG courses to critical care courses/classes to being on the floor, I have been learning new information constantly! I won't lie, there have been times where I have felt like "Geez! Will I ever get the hang of this?" but I have been told that this feeling is abnormal and that it takes time to reach the point where you actually feel like "I got this". With that being said, I am remaining patient and really working on grasping the 'BIG PICTURE' AKA understanding the 'why' behind everything I do and not just the 'what and how' AKA CRITICAL CARE NURSING!



                                  

(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).
             

Sunday, May 10, 2015

"Soy una estudiante enfermera"

A year ago today, I studied abroad to Guadalajara with my school..


5/10/2014: Day 1- “We’re here!”
            We arrived in GDL today and rode in a van from the hospital to the Universidad of Guadalajara to meet up with our housing hosts that we would be living with for the duration of our stay. Each student is assigned to a house with one other classmate. Traditionally, the hosts are the matriarch of the household. Our host preferred to be called "ma-ma". Upon arrival at our mamas we met the family members of the household and ate lunch which consisted of pig’s feet soup and tortilla chips. We consumed the same for dinner followed by ice cream and cake. Today I learned that family is a big aspect in the Mexican/Latino culture. Many families can live in one household with the mother being the sole caretaker of everyone whereas, in my household it’s just me my mom and my dad and we all try to help each other out. I have been practicing my Spanish in communicating with the family.

5/11/2014: Day 2- “Time to see the city”
            Today we went sightseeing on double decker tour bus. Our final destination led us into the city of Tlaquepaque where we were able to shop at a number of kiosk located along a strip. There was also a live mariachi band that played in the middle of the strip as we traveled through. The women had on huge, colorful, flowing dresses and the gentlemen wore these suits with colorful quilts on their shoulders. Following our shopping expedition we ate lunch at a restaurant called El Parian, ordering a several large dishes for eating from the group. It was delicious! Later that evening, there was a music concert by a group called Negro Gato and they performed about six different songs. Afterwards we went for dinner at a restaurant nearby that also had live music and caught a taxi home.




5/12/2014: Day 3- Hospital de Civil/Universidad de Guadalajara
            Today was our Orientation day at Hospital de Civil. We were led by a Carina, our host. She started us off in a room watching a video via projector on the history of the hospital. We then sat in on the commencement of the Nurses Day ceremony singing hymns and celebrating the field of nursing as it is expressed in Mexico. Shortly following the ceremony, we traveled to the floors to select which floors we were going to work on. The elevators were not working today so we had to take the stairs to Piso (Level) 12. I chose to work on Piso 12, the Medica Interna (Internal Medicine) floor, with a few  other students. Following the hospital, we go to Spanish class at Universidad de Guadalajara.


5/13/2014: Day 4- Hospital de Civil/Universidad de Guadalajara
            My day started off a little rocky due to the water not being available this morning or last night for me or my partner to shower, but I embraced it. Our mama walked us to the school today which was about a 25 minute walk. After everyone was present at the school, we rode in a van to the Hospital. Today was our first day on Piso 12. I began my day charting with the charge nurse, Leti. She showed me how to fill out the paper charts in preparing for the shift. I like how they utilize the four-color-click pens to differentiate when charting vital signs. Green is used when charting respirations, red is used for temperature, black or blue is used when charting the blood pressure and pulse. The nurses do not check pulse oximetry as a part of their daily vitals as we do. After charting and preparing for the morning, I took a few vitals, gave a Heparin shot and helped my nurse change her beds. In Guadalajara, it is not within the nurses’ scope to assess their patients as we do in the U.S. The doctors do all the assessing and there is a phlebotomist that draws blood for labs. In leaving for post conference we had a scare to day when a fellow classmate fainted. Ultimately, he was taken to the ER where our instructor met us and stayed with him. In traveling from a classmate’s house to the school for Spanish class, my partner and I took a taxi and were taken to the wrong school. We called our mama and were able to find our way but it was definitely a learning experience. 

5/14/2014: Day 5- Hospital de Civil/Universidad de Guadalajara
            This morning started off much better than the last. My partner and I were able to switch houses with much better accommodations and living circumstances. I had peaceful sleep and water to shower with last night. My partner and I walked to the top of the street and caught a taxi to the school. From there we rode to the Hospital. Today was our second day on Piso 12. We started the day off prepping our paperwork and writing in the necessary details for the shift, only today I worked with a different nurse, Carrita. Leti was tied up with scheduling and suggested I work with Corrita today so I can be on the floor more. It was pretty much the same routine as yesterday as far as medications and changing of the beds go. At lunchtime, a surprise awaited us because our wonderful nurses had a mini party for us with food and soda. We ate many traditional Mexican dishes such as Chorizo, tortillas, guacamole, re-fried beans etc. Following the hospital we went to Spanish class and learned about different verb tenses and a couple of words and names used in the medical profession. I love our teacher and the way she teaches the class. We figure out what is being said by her acting it out in a sense, instead of just telling us in English.

5/15/2014: Day 6- Hospital de Civil/Universidad de Guadalajara
            Upon awakening our mama made us a light breakfast with fruit and freshly squeezed orange juice. My partner and I walked to the top of the street and caught a taxi to the school. From there we rode to the Hospital. It was our third day on Piso 12 and an interesting one at that. One of the patients I saw in a room with one of my patients passed away last night. His diagnosis was Hepatitis B and he was delirious for most of the day yesterday, getting up out of bed and crashing to the floor, bleeding from a would he kept aggravating by falling the exact same way each time he would try to get out of bed. It was sad to know he had passed away, but it was a relief to know he is no longer suffering. After charting, passing medication, and hanging fluids my nurse and I changed beds and were done for the day. We were talking about the differences in roles of nurses in the U.S vs nurses in Guadalajara.  

5/16/2014: Day 7- Hospital de Civil/Universidad de Guadalajara (Last day)
            This morning we awoke to delicious fruit and freshly squeezed orange juice. Today was our last day working at Hospital de Civil on Piso 12. It was more emotional for me than expected but none the less a pleasant day. Our nurses planned a going away party for us with great, home cooked meals and sodas. My overall experience working at this Hospital has been an enjoyable. The language barrier was a bit challenging the first couple of days but I could figure out what was being said based on my nurse’s body language. In working here the past few days, I have learned that healthcare is not the same everywhere you go. Safety is always a concern at the hospitals here in Guadalajara because there is a lot of crime that isn’t as closely monitored as it is in the U.S. Every morning, there is a long line wrapped around the building from the all the security checking that takes place upon entering.  The way healthcare is run in Guadalajara is completely different than it is in the United States. Working here has taught me to always appreciate the opportunities and supplies that are taking for granted in the U.S. 

5/17/2014: Day 8- “Jordana AMA tu Salud-The Health Fair!”
            Today we packed an overnight bag and our projects for our trip to Juanacatlan to do our health fair in the mountains. The commute was about 2 hours and was very bumpy due to the mountainous terrain. Once we arrived in Juanacatlan, we ate at a small family restaurant where we met the Governor of Jalisco and some individuals from AMA. After finishing our meal, we rode to the location where the health fair was conducted and begin setting up our stations. I was shocked to see the living circumstances of the town we were in and the appearance of the individuals attending the health fair. Many of the families consisted of women and children. My partner and I were given the topic Diabetic foot care and hygiene. We provided several handouts and visual aids on poster board to better communicate the information since we were not fluent in Spanish. We did have help from volunteers translating the information and questions to facilitate with the language barrier. There were several individuals who had to be taken to the hospital due to their status at the other health hair modules (i.e. High BP, high blood sugars etc). Overall, my experience today was definitely very humbling and I realized that there are a lot of things I take for granted living in the U.S. We ended our day at some cozy cabins in the mountain with a great meal and some good ole Karaoke to follow before sleep.


5/18/2014: Day 9- “She’ll be coming around the mountain, when she comes!”
            Today we took left our comfortable cabins enroute to see more of this city as we make our way back to Guadalajara. It was a fun, relaxing day filled with sightseeing, zip lining and horseback riding and more shopping of course. We ate a great breakfast earlier in the day and finished with a dinner at our mama’s. After that my partner and I met up with a few other students for some bowling at the mall. The rest of the night consisted of packing our things and spending time with our Mexican families as it will be our last night in Guadalajara.  


5/19/2014-Day 10 (Last day in MX) “Adios Guadalajara!”
            Today we met at the airport to head back to Dallas for our 2 hour layover and then to home sweet home we go! I enjoyed this trip and will never forget the people who made it worth he while. I learned so much about the Mexican cultural and was actually just beginning to feel comfortable with the language. My partner and I were the first to arrive to the airport. We grabbed Starbuck’s and waited for the others to arrive. After receiving out boarding passes we proceeded through security and customs and boarded the plane.




(Disclaimer: The clinical suggestions, advice and recommendations described on sicunurse.blogspot.com are based on my personal opinions and are not medical advice. The content is for entertainment purposes only. I, surgicalnurse.blogspot.com, do not own, nor did I create any of the animations above. I did create the captions written above and below them, customizing them to my experiences along with learning tips I have found helpful in my practice).